Provider Demographics
NPI:1548295181
Name:FOOT SPECIALISTS OF MEMORIAL
Entity type:Organization
Organization Name:FOOT SPECIALISTS OF MEMORIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-464-3775
Mailing Address - Street 1:915 GESSNER RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2527
Mailing Address - Country:US
Mailing Address - Phone:713-464-3775
Mailing Address - Fax:713-464-5325
Practice Address - Street 1:915 GESSNER RD
Practice Address - Street 2:SUITE 460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2527
Practice Address - Country:US
Practice Address - Phone:713-464-3775
Practice Address - Fax:713-464-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14951Medicare UPIN
TXU52603Medicare UPIN
TX0528620001Medicare NSC